Harun Maruf
Thursday January 19, 2023
FILE - Somalia Conflict takes toll on civilian mental health. A Somali soldier provides security as newly displaced Somalis gather at a camp on the outskirts of Mogadishu, Somalia, March 28, 2017.
WASHINGTON — People in Somalia are highly traumatized due to political instability, prolonged violence and humanitarian crisis, a new health study said.
The joint study by the United Nations, Somalia's health ministry and the country’s national university found that mental disorder is prevalent across the country. It said that cases are about 77 percent higher than a previous study by the World Health Organization (WHO), which suggested that nearly 40% of the population in Somalia had a mental or psychological disorder.
The study further said that the prevalence of mental disorders among the young is significantly higher than previously reported.
“There is a high prevalence and wide range of the various mental disorders (76.9%), substance abuse disorders (lifetime, 53.3%; current, 50.6%) and poor quality of life in both non-clinical and clinical populations,” the study said.The study obtained by VOA Somali Service was conducted between October 25 and November 15 2021. The data was collected from 713 participants in the towns of Baidoa, Kismayo and Dolow. The majority of the participants (68.1%) were younger than 35 years and 58.5% were males.
All three towns host internally displaced persons who have been impacted by conflicts, and droughts which forced the pastoral communities to migrate to urban locations in search of food, water, and safety.
"Conflicts and clashes have brought about mental illness because we face many of these challenges in our country," a young person in Kismayo who was interviewed for the study told the researchers. "For example, explosions occur, and the witness might live with the shock and trauma that can affect their state of mind and even cause mental illness. Stress caused by joblessness also leads to mental health issues."
The study is a collaboration between the WHO, the United Nations Peacebuilding Fund, the United Nations Children’s Fund (UNICEF), the International Organization for Migration (IOM), the Federal Ministry of Health and the Somali National University (SNU).
According to the WHO, which led the research, this is the first-ever epidemiological study on mental health in Somalia.
"The study findings clearly indicate the prevalence of mental health disorders is higher in the younger population than we initially used to think or assume through various estimates," said Dr. Mamunur Rahman Malik, WHO Country Representative.
"Our earlier WHO study suggested that only 40% of the population in Somalia might have a mental or psychological disorder. But what we have seen now is 76%, which is a high prevalence rate," Malik told VOA.
Somalia Minister of Health Dr. Ali Haji Adam agrees that mental health situation among the population is “very poor.”
“There has been armed conflict, poverty, fear, instability, and unemployment for a long time; this is causing mental wounds,” Adam said. “They cannot cope with what is happening in front of them; mothers and children are being killed in front of them and that is damaging their mental health.”
Malik said a worrying finding is that the most common mental health illness among this population is panic disorder and post-traumatic disorder.
“Panic disorder, 39%, and post-traumatic disorder at 37%. And this is amongst the young age group,” Malik said.
He said if untreated, this might lead to suicidal tendencies. He said in previous estimates WHO saw the suicide rate among the young population in Somalia as one of the highest in the world, 14 to 15 per 100,000 population. This new study finds that the risk of committing suicide among young people in Somalia is 22 per 100,000.
The authors of the study said this is surprising for a community where Islam is the predominant religion, and where teaching prohibits suicide. They urged clinicians to consult with their patients about suicidal thoughts during evaluation, regardless of religious beliefs or practices.
Substance abuse
The other discovery of the study is the high degree of prevalence of substance abuse among the young population.
Adam said that the younger generation who are the most affected by mental health illnesses are turning to drug abuse.
"A young person with an ambition, and a future when they cannot realize their ambition and aspiration, cannot find a job they face mental pressure," Adam told VOA. “It’s likely they turn to drug abuse."
Malik agrees that the hopeless situation and lack of sufficient access to mental health facilities are driving the mentally ill to resort to the abuse use of prohibited substances.
"These are coping mechanisms, but this is self-destruction, that's the most worrying factor for me," he said.
The most common substance used was tobacco, 38%, followed by sedatives which is 37%, and these are not regulated in the country, Malik said.
He said Somalia is the only country that has not ratified the WHO's global convention on Tobacco Control. He urged the Somali government to ratify and commit to controlling substance abuse of tobacco and sedatives.
"We are actually at risk of losing a whole generation because these young people have no hopes for the future and they comprise 70% of the people in this country," Malik said. "Instead of using them as human assets we are at risk of losing them because there is a high burden of mental health and substance abuse, and this is making them non-productive and they're becoming a huge economic burden."
The increased mental illnesses can be seen in mental health care clinics.
Dr. Liban Mohamed Omar opened a mental health clinic eight months ago after he returned from Europe. He says his polyclinic and psychiatric center receives dozens of patients every week.
"Of the patients I receive, two to three out of every four persons have got mental health issues," Omar told VOA.
In addition to the political and social upheavals in the country, women face specific challenges that exacerbate their mental health situation.
“Women face many [cases of] abuse, such as rape,” Omar said.
Omar cited a lack of awareness and a shortage of skilled mental health workers and services which forces many to resort to substance abuse and to even contemplate ending their life.
Peace building
The researchers see improving mental health as an integral part of peace-building in Somalia, a country where there has been civil strife since the collapse of the state in 1991.
Malik said in conflict-affected countries the burden of mental health is high.
“These young people who were carrying a huge burden of mental health can be an easy target for radical forces because these are disillusioned young people,” Malik said.
“Our assumption is if these people can be socially integrated after addressing their mental health condition, social cohesion, and community reconciliation may increase and that can lead to peace-building in a way that these mentally ill young people may not be the targets of radical forces so they can contribute to the society.”
Malik said only 5 to 10 percent of the primary healthcare centers in Somalia currently can offer mental health services, far less than what is needed.
“The total number of mental health professionals in Somalia is 82 in a population of over 15 million,” Malik said. “And if you compare it in terms of mental health professionals, 100,000 population it is less than one. So, the future lies in investing in mental health services at the primary health care level.
The study recommended training of frontline health care workers, increased awareness, and routine screening of mental disorders at the primary health care level.